{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:34:28Z","timestamp":1761129268871},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T00:00:00Z","timestamp":1443657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,10,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Learning a new technique, even for an established surgeon, requires a learning curve; however, in transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results due to a learning curve.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>In this context, we have tried to build a learning concept for vaginoplasty that includes four steps: (i) formal identification of the surgical steps in order to provide both measure of surgical process and measures of outcomes; (ii) training on cadavers with expert assistance; (iii) performing the live surgery with assistance from expert; and (iv) performing the surgery alone. Herein, we emphasize the second step of our learning concept.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Material and Methods<\/jats:title>\n                  <jats:p>Between September 2013 and December 2013, 15 cadavers were operated on by an established surgeon learning vaginoplasty under assistance from two expert practitioners. Mean global time and mean time necessary to perform each step of the operation were recorded by the experts. Intraoperative complications were systematically registered. The final depth and diameter of the neaovaginal cavity were precisely measured. For each cadaver, the aesthetic results were assessed by one of the experts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean total operating time was 179\u2009\u00b1\u200934 minutes and decreased from 262 minutes for the first training attempt to 141 minutes for the last one. Intraoperative expert correction included modification of the scrotal triangular flap design and change of position of the urethra: This happened during the first training. No lesion of the urethra or of the anus occurred. The two experts judged the outcomes as excellent in seven cases, very good in four cases, good in two cases, and fair in two cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Despite the numerous reports on vaginoplasty in the literature, there is a real lack of published information on the learning curve of this operation. We make the hypothesis that introducing a learning concept with assistance from expert practitioners at the beginning of the surgeon's experience can optimize both the duration of his learning curve and reduce the risk of major complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1111\/jsm.12996","type":"journal-article","created":{"date-parts":[[2015,10,20]],"date-time":"2015-10-20T16:21:30Z","timestamp":1445358090000},"page":"2074-2083","source":"Crossref","is-referenced-by-count":10,"title":["Vaginoplasty in Male-to-Female Transsexual Surgery: A Training Concept Incorporating Dissection Room Experience to Optimize Functional and Cosmetic Results"],"prefix":"10.1093","volume":"12","author":[{"given":"F. M.","family":"Lecl\u00e8re","sequence":"first","affiliation":[{"name":"Centre of Expertise for Sex Reassignment Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Department of Plastic & Transsexual Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Burn Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Hand Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"CHU University of Bordeaux \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Centre Fran\u00e7ois-Xavier-Michelet \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Groupe Hospitalier Pellegrin \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Casoli","sequence":"additional","affiliation":[{"name":"Centre of Expertise for Sex Reassignment Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Department of Plastic & Transsexual Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Burn Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Hand Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"CHU University of Bordeaux \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Centre Fran\u00e7ois-Xavier-Michelet \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Groupe Hospitalier Pellegrin \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Weigert","sequence":"additional","affiliation":[{"name":"Centre of Expertise for Sex Reassignment Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Department of Plastic & Transsexual Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Burn Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Hand Surgery \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"CHU University of Bordeaux \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Centre Fran\u00e7ois-Xavier-Michelet \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"},{"name":"Groupe Hospitalier Pellegrin \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 , Bordeaux , France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2015,10,1]]},"reference":[{"key":"2023010713375780300_bb0010","article-title":"Man into woman","author":"Hoyer","year":"1933"},{"key":"2023010713375780300_bb0015","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1111\/jsm.12868","article-title":"Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques","volume":"12","author":"Horbach","year":"2015","journal-title":"J Sex Med"},{"key":"2023010713375780300_bb0020","article-title":"Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome","author":"Laub","year":"1973"},{"key":"2023010713375780300_bb0025","first-page":"294","article-title":"Vaginoplasty in male-to-female transsexuals by inversion of penile and scrotal skin","volume-title":"Reconstructive and plastic surgery of the external genitalia, adult and pediatric","author":"Hage","year":"1999"},{"key":"2023010713375780300_bb0030","article-title":"5-year experience with one-stage vaginoplasty: results and techniques","author":"Bowers","year":"2009","journal-title":"Paper presented at: Biannual Meeting of World Professional Association for Transgender Health; June 18"},{"key":"2023010713375780300_bb0035","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1046\/j.1464-410x.2000.00934.x","article-title":"Vaginoplasty in male transsexuals using penile skin and a urethral flap","volume":"86","author":"Perovic","year":"2000","journal-title":"BJU Int"},{"key":"2023010713375780300_bb0040","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/01.prs.0000185999.71439.06","article-title":"Gender identity disorder: General overview and surgical treatment for vaginoplasty in male-to-female transsexuals","volume":"116","author":"Selvaggi","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"2023010713375780300_bb0045","first-page":"427","article-title":"The results of sensated clitoris and labia minora reconstruction using dorsal neurovascular glans penis preputial island flap (Chonburi flap) in MTF reassignment surgery","volume-title":"Paper presented at: 9th Oriental Society of Aesthetic Plastic Surgery (OSAPS); December 6\u201310","author":"Watanyusakul","year":"2004"},{"key":"2023010713375780300_bb0050","first-page":"1","article-title":"Male-to-female vaginoplasty: Preecha's surgical technique","volume":"30","author":"Wangjiraniran","year":"2014","journal-title":"J Plast Surg Hand Surg"},{"key":"2023010713375780300_bb0055","doi-asserted-by":"crossref","DOI":"10.1007\/s00266-015-0552-2","article-title":"Description of the Baudet surgical technique and introduction of a systematic method for training surgeons to perform male-to-female sex reassignment surgery","author":"Lecl\u00e8re","year":"2015","journal-title":"Aesthetic Plast Surg"},{"key":"2023010713375780300_bb0060","doi-asserted-by":"crossref","first-page":"122","DOI":"10.2514\/8.155","article-title":"Factors affecting the cost of airplanes","volume":"3","author":"Wright","year":"1936","journal-title":"J Aeronaut Sci"},{"key":"2023010713375780300_bb0065","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/01.sap.0000238428.91834.be","article-title":"Genital sensitivity after sex reassignment surgery","volume":"58","author":"Selvaggi","year":"2007","journal-title":"Ann Plast Surg"},{"key":"2023010713375780300_bb0070","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/nrurol.2011.46","article-title":"Gender reassignment surgery: An overview","volume":"8","author":"Selvaggi","year":"2011","journal-title":"Nat Rev Urol"},{"key":"2023010713375780300_bb0075","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1097\/01.med.0000436190.80104.56","article-title":"Sex reassignment surgery for transsexuals","volume":"20","author":"Worblewski","year":"2013","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"2023010713375780300_bb0080","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.bjps.2007.12.009","article-title":"Evaluation of surgical procedures for sex reassignment: A systematic review","volume":"62","author":"Sutcliffe","year":"2009","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2023010713375780300_bb0085","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1111\/jsm.12915","article-title":"Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques","volume":"12","author":"Lecl\u00e8re","year":"2015","journal-title":"J Sex Med"},{"key":"2023010713375780300_bb0090","doi-asserted-by":"crossref","first-page":"c6260","DOI":"10.1136\/bmj.c6260","article-title":"Shifting the learning curve","volume":"341","author":"Reynolds","year":"2010","journal-title":"BMJ"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609515344349?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609515344349?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/10\/2074\/48475663\/jsm_12_10_2074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/10\/2074\/48475663\/jsm_12_10_2074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T14:43:34Z","timestamp":1675953814000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/12\/10\/2074\/6966726"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,1]]},"references-count":17,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2015,10,1]]},"published-print":{"date-parts":[[2015,10,1]]}},"URL":"https:\/\/doi.org\/10.1111\/jsm.12996","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,10]]},"published":{"date-parts":[[2015,10,1]]}}}